Symptoms for the baby may include:
Symptoms for the mother may include:
An anterior tongue tie (or ankyloglossia) is when a membranous band of tissue (frenum) tethers the bottom of the tongue to the floor of the mouth. A posterior tongue tie or sub mucosal tongue tie refers to the ligament hidden under the mucosa that is not visible but can be palpated. This can restrict the movement of the tongue resulting in a decrease in the efficiency of nursing. Many of the babies we see have had the anterior membrane snipped but still continue to have difficulties. If the posterior tongue tie remains, it can inhibit the tongue from lifting high into the palate and forward to seal the lower lip whilst efficiently expressing and transferring the milk in a swallowing motion. A deep attachment with the tongue forward over the lower jaw’s bony ridge is also required to cushion and protect the mother’s nipple. Most babies should be able to empty the breast without discomfort to the mother in 10-15 minutes. If a baby is tongue tied, it can take much longer or they will tire easily having shorter and more frequent feeds.
If the upper labial frenum is tight, the infant will not be able to flange their upper lip comfortably and the lips wide enough to get a deep attachment. This is commonly known as an upper lip tie. The baby’s opening is more an oval shape rather than round with the dry lip rather than moist mucosa contacting the areola or bottle teat. This results in an inadequate seal and can lead to air being swallowed and milk spilling out the sides. With a shallower attachment, a typical result is the baby becomes frustrated and tired, often chomping or biting the nipple leading to maternal trauma and pain.
Treating an infant is not a simple quick snip. The involvement of a qualified lactation consultant is the first step in helping to overcome nursing difficulties and to discuss the possible benefits of a frenectomy. At the lactation consultant’s recommendation, a consultation will then be booked for an examination/treatment with Dr Johnston. This ensures that the parents have enough information to make an informed decision to proceed to treatment. The indication for treatment in an infant is to improve nursing, both breast and bottle. It is an elective surgical procedure that should only be done if the parent feels the symptoms warrant it.